As previously reported, on July 7, 2014, CMS issued the Calendar Year 2015 Home Health Prospective Payment System Proposed Rule (Proposed Rule). On August 18, 2014, the American Hospital Association (AHA) submitted comments on the Proposed Rule and addressed CMS’s proposed changes to the face-to-face encounter requirements. AHA noted that home health agencies and physicians “have struggled to comply with the face-to-face encounter requirement,” and AHA acknowledged CMS’s efforts to “streamline [the face-to-face] requirement.” AHA believes that streamlining the face-to-face requirement will “facilitate smoother transitions for hospitals discharging patients to home care and for hospital-based [home health] agencies initiating services.”

In the Proposed Rule, CMS included changes to simplify the home health face-to-face encounter requirements. For example, CMS proposed to eliminate the narrative requirement in 42 C.F.R. § 424.22(a)(1)(v), except when a patient requires skilled nursing care for management and evaluation of the patient’s plan of care. In this scenario, a physician narrative would still be required. AHA recommends that CMS clarify in the final rule the limited circumstances in which a narrative would be required. In all cases, the certifying physician would still be required to certify that a face-to-face encounter occurred and document the date of the encounter as part of the certification of eligibility.

CMS also proposed to clarify that under sections 1814(a)(2)(C) and 1835(a)(2)(A) of the Social Security Act, the face-to-face encounter requirement is applicable for certifications (not recertifications), rather than initial episodes. It further sought to clarify that a patient discharged following the completion of his or her home health plan of care that is subsequently readmitted during the same 60-day period would require a new certification (thus, a face-to-face encounter would be required), not a recertification. AHA recommends that CMS only require a new face-to-face encounter “when the patient returns to [home health] care during the same 60-day episode for treatment of a new condition.”

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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